title: The dilemma of a rising prostate-specific antigen level after local therapy: what are our options?
abstract: Prostate cancer is the most common solid tumor diagnosed in men in the United States and Western Europe. Primary treatment with radiation or surgery is largely successful at controlling localized disease. However, a significant number (up to one third of men) may develop biochemical recurrence (BR), defined as a rise in serum prostate-specific antigen (PSA) level. A general presumption is that BR will lead to overt progression in patients over subsequent years. There are a number of factors that a physician must consider when counseling and recommending treatment to a patient with a rising PSA. These include the following (1) various PSA-based definitions of BR; (2) source of PSA (ie, local or distant disease, residual benign prostate); (3) available modalities to treat the disease with the least morbidity; and (4) timing of therapy. In this article we review the current and future factors that clinicians should consider in the diagnosis and treatment of recurrent prostate cancer.
authors.affiliation: Department of Radiation Oncology, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA 19107, USA.
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Zaorsky
authors.forename: Ganesh V
authors.initials: GV
authors.lastname: Raj
authors.forename: Edouard J
authors.initials: EJ
authors.lastname: Trabulsi
authors.forename: Jianqing
authors.initials: J
authors.lastname: Lin
authors.forename: Robert B
authors.initials: RB
authors.lastname: Den
mesh_terms: D003131:Combined Modality Therapy; D003452:Cryosurgery; D019583:Dose Fractionation, Radiation; D006801:Humans; D007610:Kallikreins / Q000097:blood*; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000097:blood* / Q000517:prevention & control; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000628:therapy; D018570:Risk Assessment; D016879:Salvage Therapy; D016896:Treatment Outcome
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen